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PAEDIATRICS > Cardiac system and Exam > Flashcards

Cardiac system and Exam Flashcards

1
Q

State the purpose of positioning a cardiac patient in 45 degrees

A

Because supine position may cause breathlessness

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2
Q

State the 3 types of endocarditis and presenting features

A

Infective - Osler nodes
Bacterial - Janeway lesions
Acute bacterial - Hemorrhagic lesions and subungual hemorrhages

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3
Q

State 4 causes of differences in radial pulses

A

Coarctation of the aorta
Dissecting aneurysm
Peripheral embolism
Aortitis

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4
Q

State a cause of radio-femoral delay

A

Coarctation of the aorta

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5
Q

State 5 causes of difference in pressure in the upper and lower limb

A

Aortitis
Coarctation of aorta
Blockage at aorta bifurcation(adominal) - into common iliacs
Dissection of aorta - due to injury causing blood to flow between layers of the wall
Arteriosclerotic obstruction

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6
Q

Describe systolic murmur and its two types

A

Systolic murmur is heard between S1 and S2
Ejection- there is a gap between S1 and murmur
Regurgitant- no gap between S1 and murmur

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7
Q

State where mitral, aortic and pulmonary murmurs radiate to

A

Mitral- axilla
Aortic- neck
Pulmonary and coarctation- back

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8
Q

State features of a silent murmur x4

A

Soft grade 1/6 or 2/6 at left sternal angle
Normal vital signs and examination
No audible click
Normal pulses

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9
Q

Features of a hemodynamically significant murmur x5

A

•Grade ≥ 3/6
•Harsh quality
•Best heard in the upper left sternal edge
•Abnormal 2nd heart sound
•Femoral pulses difficult to feel
•Abnormal vital signs or clinical examination

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10
Q

Define hypoplastic left heart and 2 cases in which one can survive with it

A

The left side of the heart is underdeveloped hence it can not support systemic circulation resulting in cyanosis
PDA and PFO patent foramen ovale

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11
Q

State 2 things that precipitate duct closure

A

Oxygen and steroids

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12
Q

Define persistent fetal circulation

A

Persistent postnatal right to left ductal or atrial shunting in the presence of elevated right ventricular pressure

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13
Q

State 2 duct dependent heart diseases

A

Transposition of great vessels
Pre ductal coarctation of the aorta

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14
Q

Treatment of cyanotic spells x4

A

1.Oxygen- decrease peripheral pulmonary vasoconstriction
2.Analgesics- release catecholamines hence decrease HR and relax infundibular spasm
3.IV fluid bolus- improve right ventricular preload
4.Squatting or sitting position- increase systemic resistance and promote systemic return to heart

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15
Q

State 3 causes of VSD

A

Intrauterine infections TORCH
Genetic syndromes eg Downs
Maternal risk factors eg smoking

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16
Q

Describe the pathophysiology polycythemia in heart diseases

A

Hypoxia stimulates the kidney to produce more erythropoietin which stimulates RBC production

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17
Q

Define paradoxical embolism

A

A blood clot from the inferior vena cava passes through the ASD into the arterial circulation and may result in end organ failure

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18
Q

Define rheumatic heart disease and the 2 valves it mainly affects

A

Acute rheumatic fever leading to endocardium inflammation
Mitral and aortic

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19
Q

State 4 acquired causes of heart failure

A

Rheumatic heart disease
Bacterial endocarditis
Myocarditis
Cardiomyopathy

20
Q

Presentation of cardiomyopathy and myocarditis x3

A

Poor perfusion
Heart failure
Mitral regurgitation murmur

21
Q

Treatment for heart failure x3

A

Make heart pump harder- digoxin, inotropes
Reduce workload of heart- diuretics, vasodilators
Supportive therapy- tube feeding, dietary advice and nursing

22
Q

Requirements for erythropoiesis x5

A

Vitamins- b6 b12 c e folic acid
Hormones- erythropoietin, androgens
Metals- iron cobalt manganese
Amino acids

23
Q

Erythropoiesis flow chart summary x5

A

Pluripotent hematopoietic stem cell > pro-erythroblast > erythroblast > reticulocyte(no nucleus, enters blood after 3 days) > erythrocyte (no organelles)

24
Q

Functions of the RBC membrane x4

A

Provides cellular shape
Avoid adhesion to self and vascular wall
Maintain cellular functions in transport of salts and minerals
Maintain structure and contain structures of the RBC

25
Q

Describe the Bohr effect

A

Increased concentration of CO2 AND H+ in the tissues results in unloading of O2 due to decreased Hb affinity
Shifts O2 Hb dissociation curve to the right

26
Q

Describe the Haldane effect

A

Oxygenated Hb in the lungs results in release of CO2 in the pulmonary arteries > shift of curve to the left

27
Q

Define anemia

A

The reduction in red blood cell mass or blood hemoglobin concentration

28
Q

What is the physiologic adaptation to anemia x6

A

Vasodilation
Bohr effect - decreased pH and increased temp
Increased heart rate
Increased stroke volume
Decreased O2 affinity > offloading in cells
Elevated 2,3 BPG- binds to hb and facilitates oxygen supply to tissues

29
Q

Define severe anemia

A

All children with Hb<4g/dL

30
Q

Define non severe anemia

A

Young children <6years with Hb<9.3g/dL

31
Q

Transfusion volumes for packed cells, whole blood and define large volume transfusion LVT

A

Packed cells- 10ml/kg over 3 to 4hours
Fresh whole blood- 20ml/kg over 3 to 4 hours
LVT- >20-25ml/kg over <4 hours

32
Q

Factors that affect the need for transfusion x5

A

Rate of fall of Hb
Ability to increase cardiac output
Ability to adequately oxygenate RBCs
Ability of RBCs to deliver oxygen to tissues
Ability of bone marrow to produce more RBCs
Consequences of poor tissue oxygen delivery

33
Q

State 3 purposes of NADPH produced in the pentose phosphate pathway

A

Fatty acid synthesis
Steroid synthesis
Prevent oxidative stress

34
Q

State purpose of ribulose 5 phosphate produced in the pentose phosphate pathway x2

A

Production of purines and pyrimidines
Production of ribose 5 phosphate

35
Q

Source of ATP for RBC

A

Anaerobic glycolysis

36
Q

3 causes of anemia

A

Decreased production
Increased destruction
Loss

37
Q

Indications for blood transfusion x5

A

Sepsis
Anemia
Perioperative
Acute chest syndrome
Acute neurological syndromes
Splenic or hepatic sequestration crisis

38
Q

Contraindications for blood transfusion x5

A

Disease of the blood and endocrine system
Infectious and skin Diseases
Raised intracranial pressure
Acute pulmonary edema
Congestive heart failure

39
Q

Describe where oslers nodes and janeway lesions are found

A

Osler- tips of fingers and toes. Painful
Janeway- palm and soles. Not painful

40
Q

State 5 congenital heart disease structural lesion groups

A

Septal defects
Valve abnormalities
Vessel abnormalities
Failure to transition
Major structural abnormalities

41
Q

State function of prostaglanidn E1 and indomethacin in PDA

A

E1 Helps in keeping the duct open
Indomethacin given to stimulate PDA closure
E1 produced by ductus to keep it open, indomethacin inhibits enzymatic processes that produce proglandins

42
Q

Clinical presentation of a tet spell x5

A

Agitation, cyanosis, tachypnea, pallor, floppiness and loss of consciousness

43
Q

Types of murmurs in different congenital heart diseases x4

A

TOF - ejection systolic corresponding to pulmonary stenosis
VSD - harsh pansystolic loudest at left lower sternal edge
ASD - ejection systolic murmur loudest in pulmonary area
PDA - machinery murmur

44
Q

Types of rheumatic heart disease(2) and how it causes heart failure

A

Acute pancarditis
Chronic cardiac valvular changes
Inflammation > scarring and fibrosis > deformity of the valve > heart failure

45
Q

Eisenmengers syndrome pathophysiology

A

Untreated ASD/VSD > chronic increase in pulmonary flow > pulmonary HTN > irreversible damage to pulmonary vasculature + reversed pressure gradient > R-L shunting

PAEDIATRICS (20 decks)

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